Use of halo fixation therapy for traumatic cranio-cervical instability in children: a systematic review

Purpose Traumatic cranio-cervical instability in childhood is rare and constitutes a challenge for the treating surgeon. The aim of therapy is to restore cervical stability without limiting the range of motion. The goal of this systematic review was to find out whether, over the last 10 years, halo fixation (HF) could still be considered a successful treatment option without major risks or complications. Methods We analyzed studies describing the use of HF in traumatic injuries of the cranio-cervical junction in children under the age of 17. Searches were performed in PubMed, MEDLINE and Embase databases for the years from 2010 to 2020. The general success rate, the success rate related to underlying pathologies, and complication rates were evaluated. Results The main indications for HF range from pre-surgical correction to postoperative fusion support. C2 is the most frequently injured vertebra in children. The overall success rate of HF was very high. Evaluation according to the underlying pathology showed that, except for atlanto-occipital dislocation, HF generates high fusion rates among different patient cohorts, mainly in C2 vertebra injuries and atlantoaxial rotatory subluxation. Only minor complications were reported, such as pin infections. Conclusion The current data show that, when used according to the appropriate indication, HF is an effective conservative treatment option for cranio-cervical instability, associated with only minor complications.

The Role of Digital X-Ray in Curative Effect and Nursing Evaluation of Cervical Spondylotic Radiculopathy

The present study attempted to analyze the features of atlanto-occipital radiograph in patients with cervical spondylotic radiculopathy or vertebral artery type. In order to reduce the interference of human factors and the measurement error as much as possible, this experiment adopts the blind design and analyzes the digital format X-ray films by using the computer software ImageJ. Because the tangent line between the outer plates of the anterior and posterior margin of the foramen magnum was not accurately located on the X-ray film, the angle formed by the line between the saddle dorsal slope and the center point of the anterior and posterior nodule with a clear display was selected as the measurement method of the angle between the atlanto-occipital joints. The results showed that the lateral cervical curvature of the VCS group was 0.43 ± 0.51, and the lateral cervical curvature of the CSR group was 0.46 ± 0.49, both of which were significantly lower than the normal value (1.2 ± 0.5 cm). Patients in both groups had the characteristic of cervical curvature straightening. The changes of cervical curvature in overflexion and overextension positions can indirectly reflect the state of cervical motion. The anterior flexion neck curve of the VCS group was less than that of the CSR group ( P < 0.05 ). Compared with the CSR group, VCS showed limited cervical anterior flexion movement. In this study, X-ray films of both CSR and VCS showed occipitocervical flexion and extension disorders, cervical curvature straightening, and lower cervical instability. In VCS, occipitocervical flexion and extension disorders were mainly manifested in atlantoaxial flexion disorders, while in CSR, atlanto-occipitocervical flexion and extension disorders were mainly manifested in atlantoaxial flexion disorders.

Musculoskeletal anomalies in children with Mucopolysaccaridoses

Introduction The accumulation of glycosaminoglycan (GAGs) in the tissues in Mucopolysaccharidoses (MPS) can lead to skeletal anomalies (DYSOSTOSIS MULTIPLEX) and to soft tissue impairments (neural or medullar compression, joint stiffness, tenosynovitis). Here is a review of orthopedic issues frequently encountered in patients with MPS. Material and methods Surgery may be justified at different age and according to the type of MPS. Different surgical approaches and their indications are exposed in the article. Results The article exposes indications and techniques for orthopedic issues in MPS children: cervical stenosis, cervical instability, kyphosis, hip dysplasia and hip dislocation, genu valgum. Conclusion Various musculoskeletal anomalies can be found in patients with mucopolysaccharidoses. Neurological impairments are frequently seen due to cervical stenosis or instability and should be early detected with regular MRI of the cervical spine. Well-codified management should lead to favorable functional results and maintain functional and walking abilities.

Pathological axis fracture secondary to a solitary bone plasmacytoma: Two cases and a literature review

Background: Solitay bone plasmocytoma (SBP) account for just 5–10% of all plasma cell neoplasms. They are infrequent in the cervical spine, especially involving the C0–C2 segment. In this article we conducted a literature review and present the diagnosis, management and long term course of two patients with SBP of C2 causing cervical instability. Methods: We assessed the clinical records of two patients with SBP in C2 and cervical instability attributed to SP-B involving C2. Both patients presented with progressive, severe cervicalgia, and the “sensation” of skull instability. Magnetic resonance imaging revealed an extensive, infiltrative lesion involving C2 vertebral body and lateral masses, consistent with a plasmacytoma. Results: Both patients underwent emergency posterior surgical stabilization with craniocervical fixation; this was accompanied by a C2 transpedicular biopsy. Postoperatively, patients exhibited no focal neurological deficits and rapidly became pain free. They additional recieved 25 sessions of local conventional radiation therapy. Both patients are doing well as respective 2 and 7-year follow-up. Conclusion: Although rare, unstable SBP may present atypical cervical location that readily responds to surgical descompression/fusion and radiotherapy.

Cervical instability in a patient with rheumatoid arthritis

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune connective tissue disease characterized by symmetrical arthritis associated with extra-articular changes. Although peripheral joint involvement is the dominant symptom of RA, many patients develop cervical spine involvement in the course of the disease, manifesting as cervical instability. Aim: The aim of this study is to describe a case of an RA patient with spinal myelopathy to increase awareness of this complication, hoping that its early diagnosis may prevent further serious consequences. Case study: A 63-year-old patient, who was diagnosed with RA 18 years ago, was admitted to the Rheumatology Clinic due to suspected exacerbation of rheumatic disease. Functional X-Ray and MRI was performed, which showed instability in the C3–C4 segment with spinal cord compression. Subsequently, the patient underwent cervical spine surgery. After the surgery and rehabilitation, the patient demonstrated neurological improvement. Results and discussion: Every patient diagnosed with RA should be educated about the possibility of a complication of cervical instability and be familiar with the neurological symptoms that may result from it. If cervical instability and subsequent cervical myelopathy are detected early, the symptoms may be reversible or significantly reduced by surgical spinal cord decompression and cervical stabilization. Conclusions: It is very important to perform a functional X-ray of the cervical spine to exclude instability, especially before rehabilitation treatment. Neck pain in patients diagnosed with RA may indicate cervical instability that requires more thorough neurological examination to exclude cervical myelopathy.

Cervical and scapular instability in subjects with temporomandibular disorder

Background: Temporomandibular disorder (TMD) is a set of disorders involving the masticatory muscles, the temporomandibular joint (TMJ) and/or the associated structures. Objectives: To evaluate the occurrence of cervical and scapular instability in subjects with TMD. Methods: A total of 22 patients participated in the study, being 11 of them with TMD, selected using the RDC/TMD criteria, and 11 in the control group. The stabilization capacity of the neck muscles was evaluated through StabilizerTM and the muscles of the shoulder girdle through specific tests. Cervical mobility data from both groups were provided using the accelerometer while for cervical disability was used the Neck Disability Index (NDI) questionnaire. Results: Cervical instability was higher in the TMD group (20.36 ± 3.2) than in the control group (28.54 ± 0.8), revealing significant difference (p= 0.03). The highest percentages of scapular stabilization tests were found in subjects with TMD, (n= 9; 81.81%) when compared with control subjects (n= 5; 45.45%). The NDI results showed that the TMD group presented mild cervical incapacity (11.18 ± 2) and the control presented no disability (2.27 ± 0.4; p= 0.001). Conclusion: Cervical disability, and cervical and scapular instability were more frequent in subjects with TMD.